[Editor’s Note: After reading Kevin Reese’s firsthand OWCP account on this blog site–that also appeared in the Fall 2019 Issue of Two More Chains–Adam Crichton was motivated to share his own OWCP experience and the lessons he learned from this ordeal in hopes his story might help others in the future.]

By Adam Crichton, Engine Operator

I have a similar story to Kevin Reese’s experience with OWCP.

On May 8, 2018 I was injured during physical training—although, initially, I didn’t realize this. I had done a normal workout routine of a run and sit-ups, push-ups, and pull-ups.

That evening I was feeling sore. I was like: “Man, that was a good workout.”

But the next day I go back to work and I’m just not feeling right. I decided to push through it, thinking it will wear off. I do another light work-out and then attended a Smokey Bear event—when I noticed my arms were not extending all the way.

That evening I got home and got ready for bed and my wife tells me: “You look really swollen.” That’s when it dawned on me that I could have Rhabdomyolysis. I started looking on my phone for a bulletin that had been sent out earlier that year about Rhabdo.

The next morning, I get up and I’m hurting badly. I start calling my supervisors. They tell me that I need to go to the hospital and be tested for Rhabdo. So the morning of May 10, I go to the urgent care facility and hand them the Rhabdo informational paper and explain that I need the Rhabdo blood test. Four hours later, I get called to come back in. My supervisor goes with me. He has the CA-1 filled out properly. It was good to go, I thought. I get told that my CPK-level is off the charts. I was hospitalized for the next seven days.

That’s when the headache starts with OWCP and the fight to get things taken care of.

 

Denied for All Treatments

On May 23, I get my first letter saying that I have been denied for all the treatments and everything. I talk to my local OWCP representative about this. That starts my follow-up calls.

I called and resubmitted all the paperwork to OWCP on May 28. After a review process, on July 9 they finally accept paying for my hospital stay—under the condition of “Rhabdomyolysis ICD-10 code M6282.”

At first, I felt a relief of pressure thinking that this is all going to work out. My supervisors assure that everything will be taken care of, everything is covered, I don’t have anything to worry about. And, initially, my medical bills were being accepted and everything was going smoothly—until February 2019. Nine months after my injury had happened. That’s when I start receiving the bills.

I take this up with my supervisor and explain how I’m getting billed for a work-related injury and I can’t afford this.

What I didn’t know then was that after OWCP started denying the bills, the hospital pulled my personal insurance info and started billing them. Thank god for private insurance, but the hospital did this without asking about the work-related injury and all the paperwork that was submitted to them as well as to OWCP. The hospital said that’s because I am responsible for all the bills that go unpaid.

That’s when I start calling my OWCP representative. Unfortunately, she was absolutely no help. Once OWCP accepts a “condition” they do not like changing the codes.

So I told her that we needed to make a call to the hospital and talk to the billing department about this and get it corrected. That didn’t go very far. We got passed around from one person to another person. Finally, we talked to a supervisor at the hospital who informed that all billing codes are correct and that OWCP would need to accept the code and add it to my record of condition.

My OWCP representative said, “You can’t bill him for these other conditions and treatments because they don’t fall under the ‘accepted condition’.” She also stated that the hospital could lose their funding from OWCP if they don’t bill correctly under the proper condition. The hospital finally took me off the billing process and resubmitted my information for review at the hospital.

Starting to Freak Out

This review came and went and I started getting even more bills. I kept calling my OWCP representative about this. She kept saying, “I’ve called the hospital twice already and they don’t want to budge.” That’s when I realized I’m not going to get any help from the hospital or OWCP. I contacted another local human resource representative who handles OWCP claims for the agency at the BLM Nevada State Office and got him involved.

Together, we wrote a “Cease and Desist” letter to the hospital to stop the bills. We even went down there together and sat down with the hospital’s billing department people and hand-delivered it to them. That’s when we pulled my medical record to see what was being billed and what was being accept by OWCP.

At this time, we still weren’t getting anywhere. And now we’re in mid-fire season and I start getting calls saying that I’m being sent to a collections agency unless I get on a billing plan and start making payments.

I’m starting to freak out.

Lawyers Don’t Want to Fight Federal OWCP

So, I finally do some more research with my acting Engine Captain. We looked at getting a lawyer for my case to help me out. But we quickly find out that no one wants to fight federal OWCP. Not even the lawyers who deal with state OWCP claims.

Next, I realize that no one on the local level really knows how to deal with OWCP and get them to pay. I started going through my medical records again, combing through them and finding all the codes that matched the ones that were being denied.

To stay out of collection, I finally give in and make one payment to the hospital at the bare minimum. After that I received some information about who my OWCP representative’s supervisor was. So I called her informing that I need a new representative due to the lack of cooperation and work between them and the hospital. I informed them that my case needs to be reviewed due to the conditions of acceptance and that new codes needed to be added.

I submitted another letter to OWCP with the ICD-10 codes that needed to be accepted under my condition, informing that my personal insurance needed to get paid back in full because it was a work-related injury.

My Biggest Takeaway

In September 2019 (my Rhabo experience happened in May 2018) after all the stress, headache and multiple hours—spent on my work time and on my own time—I finally got through to someone in OWCP.

Since that time, even though I haven’t received any more bills, I’m still paranoid about this entire dilemma. I therefore constantly check my account at the hospital to make sure I’m not getting billed.

My biggest take away from this is no matter how much supporting documentation that you have and how many people look over your CA-1 and CA-16, it doesn’t guarantee that everything is going to be correctly taken care of and processed.

From my experience, to get things properly clarified it became a stressful fight which affected my entire family—wife and child—who I am trying to support.

It almost seems like OWCP will find a way to deny you. This becomes even more difficult on folks like me who are career seasonal employees as well as the temporary seasonal employees. I feel that there must be a better way to deal with these issues to hold both OWCP and the hospital billing process accountable. They both need to be doing a better job of talking to each other.

I know that the OWCP system has been taken advantage of in the past so new rules and regulations have come down to prevent that. But when you are an honest person who was injured at work and don’t receive the follow-up help that you’re entitled to, it hurts and makes you feel helpless.

We Can Do Better

We as an agency can do better. Maybe that’s helping district OWCP representatives get access to more training to help deal with work-related injuries. Or it’s by finding methods to make the process clearer and easier so that when a person does get hurt, they have access to someone who understands the medical language. For me, that was the most difficult part.

We should work on making more information available to employees for protocols on how to deal with these issues.

As wildland firefighters we always find a way to make things work—even if we don’t have the numbers we need or the parts. If it’s broke we fix it and can maintain it.

I hope that down the road we can make the workers comp systems work together. As my specific situation illustrated, there can be a disconnect between the hospital not making it clear what codes need to be accepted under a condition, and then OWCP not allowing more codes to be accepted.

Maybe its training between these two groups that needs to be looked at and reviewed for what would work better to make the information easier to understand and flow so that conditions get accepted. The hospital and OWCP are ultimately in charge of our fate when it comes to a work-related injury.

In conclusion, I feel for Kevin Reese and what happened to him, as well as so many others who have been injured in the line of duty.